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000 aignsnvowpo/o:snnorns1-82Fo-4xoo-BocF-6ocums4cxox - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 1. COVER PAGE (Each program requires a separate application.) <br /> a) Applicant Contact Information <br /> Applicant Organization's Legal Name: Piedmont Wildlife Center <br /> Applicant Organization's Physical Address: 364 Leigh Farm Rd, Durham, NC 27707 <br /> Applicant Organization's Mailing Address: 364 Leigh Farm Rd, Durham, NC 27707 <br /> Applicant Organization's Web Address: yvvvvv.piedmpntvvi|d|ifecenter.orK <br /> Executive Director: Gail Abrams <br /> Telephone Number: 918-489'0900 E-Mail: <br /> dinantorapiwdrnontwi|d(if*cantor.nrg <br /> DUNS Number: 008434741 <br /> (Dun& Bradstreet, Inc. provides this number at no charge,and it is required for Federal funding <br /> recipients.) <br /> b) ProjectlProqram Contact Information <br /> Project/Program Name: Nature Day Camp <br /> Project/Program Primary Contact and Title: Gail Abrams, Executive Director <br /> Telephone Number: 919'489-0900 E-Mail: <br /> dinoctorpiedmontwi|d|ifeoentor.orq <br /> c) Funding Request Identification <br /> Total P ject/Program Cost: $ 331,433 Total Amount of Funds Requested: $ 10.000 <br /> Proposed Use of Funds Requested (2-3 Line Maximum): We currently have children from <br /> Orange county that attend our Durham camps, and now we are partnering with Orange County <br /> Parks and Rec to offer camps at Blackwood Farm Park in Chapel Hill. We would like to be able <br /> to offer the equivalent of 40 scholarships to be allocated for children from Orange County to <br /> attend either the Chapel Hill or Durham camps offered throughout the year. <br /> Please check all types, sources, and amounts of funding being requested. You must submit <br /> an application package for each funding source. tThe Participating Jurisdiction reserves the <br /> right to fund projects from any funding source, subject to e and funding constraints. <br /> CDBG Non-Construction (CH) $ Grant Loan <br /> CDBG Construction (CH) Grant Loan <br /> HOME CHDO (OC) Grant Loan <br /> ����e3 23 <br />